Académique Documents
Professionnel Documents
Culture Documents
• Respiratory
acidosis
alkalosis
• Metabolic
acidosis
alkalosis
Approach
• History - subjective information concerning events,
environment, trauma, medications, poisons, toxins
• Physical examination - objective information
assessing organ system status and function
• Differentials - potential reasons for presentation
• Clinical and laboratory studies - degree of changes
from normal
• Compensation - assessment of response to initial
problem
Evaluation of Acid-Base Conditions
• Examine serum electrolytes (increased or decreased
total CO2, increased or decreased AG, increased or
decreased HCO3- gap) and ABGs (directional changes
in pH, HCO3-, and PCO2).
• Examine ABG data for mixed acid-base conditions.
• Complete clinical assessment of history, physical
examination, previous ABGs and serum electrolytes,
along with other laboratory data.
• Identify underlying clinical cause(s) for each acid-base
disorder.
• Treat the clinical conditions.
Reference ranges and points
Parameter Reference range Reference point
Na+ 135-147 mEq/L
K+ 3.5-5.0 mEq/L
Cl- 95-105 mEq/L
CO2, total 24-30 mEq/L
pH 7.35-7.45 7.40
PCO2 33-44 mm Hg 40 mm Hg
PO2 75-105 mm Hg
HCO3- 22-28 mEq/L 24 (27) mEq/L
Anion gap 8-16 mEq/L 12 mEq/L
Bicarbonate gap -6-6 mEq/L
Osmolar gap <10 mOsm/L
Evaluation of Serum Electrolytes
Total CO2
Anion Gap
Increased, >20 mEq/L Normal Decreased, <8 mEq/L
consider potential cause consider hypoproteinemia,
abnormal proteins or cations
Bicarbonate Gap
Positive, > 6 mEq/L Negative, < -6 mEq/L
metabolic alkalosis and/or hyperchloremic acidosis (HCA) and/or
HCO3- retention for respiratory acidosis HCO3- excretion for respiratory alkalosis
Evaluation of Arterial Blood Gas
Primary process Compensatory response
[HCO-3 ] -[HCO-3 ]
¯pH @ Respiratory acidosis -pH @
-PCO 2 -PCO2
[HCO-3 ] ¯[HCO-3 ]
-pH @ Respiratory alkalosis ¯pH @
¯PCO 2 ¯PCO2
¯[HCO-3 ] ¯[HCO-3 ]
¯pH @ Metabolic acidosis -pH @
PCO2 ¯PCO2
-[HCO-3 ] -[HCO-3 ]
-pH @ Metabolic alkalosis ¯pH @
PCO2 -PCO2
Delta ratio
𝛥 ratio = 𝛥Anion gap/𝛥[HCO3-] = (AG – 12)/(24 - [HCO3-])